Chapter 25, The Child with Gastrointestinal Dysfunction peds

Why does a nurse administer antipyretics to a child with acute diarrhea? 1 To reduce a high temperature 2 To treat severe dehydration and vomiting 3 To treat pathogens causing gastrointestinal losses 4 To rehydrate and replace fluid lost through the stools

1 Children with diarrhea may also have fever. Antipyretics are administered to reduce the high temperature. Intravenous fluids are administered to treat severe dehydration and vomiting. Antimicrobial agents are administered to treat specific pathogens causing gastrointestinal losses. Oral rehydration solutions are administered to rehydrate and replace stool losses.

An 8-year-old child with a stomach ulcer passes a dark-colored, tarry stool. Which term does the nurse use to document this stool? 1 Melena 2 Meconium 3 Hematemesis 4 Hematochezia

1 Melena is dark-colored, tarry stool that suggests upper gastrointestinal (GI) bleeding such as from the stomach. Meconium is the first stool of a newborn. Hematemesis is vomiting bright red blood and hematochezia is passage of bright red blood per rectum, usually indicating lower GI tract bleeding.

A child who has mistakenly ingested a foreign body is coughing and choking and has difficulty breathing and talking. What does the nurse conclude from the symptoms? 1 The foreign body may have been aspirated. 2 The foreign body may be lodged in the pharynx. 3 The foreign body may be lodged in the esophagus. 4 The foreign body may have perforated the gastrointestinal tract.

1 Symptoms such as coughing, choking, and difficulty in breathing and talking are present if the child has aspirated the foreign body. Symptoms such as discomfort in the throat or chest are present if the foreign body is lodged in the pharynx. Symptoms such as increased salivation, drooling, gagging, or difficulty in swallowing are present if the foreign body is lodged in the esophagus. Symptoms such as chest or abdominal pain, bleeding in vomitus, stool, or hematocrit are present if the foreign body has perforated the gastrointestinal tract.

Which is the most common cause of diarrhea in children under 5? 1 Rotavirus 2 Salmonella 3 Escherichia coli 4 Clostridium difficile

1 The most common cause of diarrhea in children under 5 is rotavirus. There is a high incidence of Salmonella species and Escherichia coli in the summer months, but rotavirus is the most common cause of diarrhea in children under 5. Clostridium difficile is associated with alteration of normal intestinal flora by antibiotics.

Which condition in the child brought to the emergency department is the likely cause of the symptoms of vomiting, fever, and diarrhea? 1 Infection 2 Bowel obstruction 3 Poor gastric emptying 4 Central nervous system disorder

1 When vomiting is accompanied by fever and diarrhea, the underlying cause may be an infection. When vomiting is green and bilious, the underlying cause may be bowel obstruction. When vomiting has curdled stomach contents, mucus or fatty foods, and occurs many hours after ingestion, the underlying cause may be poor gastric emptying. When vomiting is associated with change in the level of consciousness or a headache, the underlying cause may be a central nervous system disorder.

Which agents in the United States cause acute diarrhea and are transmitted through raw or undercooked food? Select all that apply. 1 Shigella 2 Salmonella 3 Campylobacter 4 Vibrio cholerae 5 Clostridium difficile

1,2,3 Agents causing acute diarrhea that are transmitted through raw or undercooked food include Shigella, Salmonella, and Campylobacter. Clostridium difficile is associated with alteration of normal intestinal flora by antibiotics. Vibrio cholerae is more prevalent in developing countries. It is found living in bodies of salt water and can contaminate food and water.

Which processes are necessary for the body to convert nutrients into forms it can use? Select all that apply. 1 Digestion 2 Absorption 3 Metabolism 4 Elimination 5 Reabsorption

1,2,3 Processes necessary for the body to convert nutrients into forms it can use include digestion, absorption, and metabolism. Elimination is a function of the gastrointestinal system but not necessary for the body to convert nutrients into forms it can use. Reabsorption is a renal function.

Which are true statements associated with pica? Select all that apply. 1 A nonfood pica example is hair. 2 Pica is considered an eating disorder. 3 A food pica example is coffee grounds. 4 Pica is more common in men and children. 5 Pica is clearly associated with protein deficiency.

1,2,3 True statements associated with pica include: pica is considered an eating disorder in which food and nonfood items are eaten compulsively and excessively for at least one month. A food pica example is coffee grounds and a nonfood pica example is hair. Pica is more common in various groups including women (not men) and children. Pica is clearly associated with both iron and zinc deficiency (not protein deficiency).

Which are clinical manifestations of gastrointestinal dysfunction in children? Select all that apply. 1 Melena 2 Jaundice 3 Encopresis 4 Failure to thrive 5 Clubbing of fingers

1,2,3,4 Clinical manifestations of gastrointestinal dysfunction in children include melena, jaundice, encopresis, and failure to thrive. Clubbing of fingers is associated with chronic respiratory problems.

A child has been experiencing acute diarrhea for the past 3 days. The practitioner suggests to first treat with oral rehydration therapy (ORT). What are the advantages of ORT? Select all that apply. 1 Safer 2 Less painful 3 More effective 4 Less costly than intravenous (IV) fluids 5 Less costly than using other types of oral fluids

1,2,3,4 The reason a practitioner suggests to first treat a child with acute diarrhea with ORT is it has the advantages of being safer, less painful, more effective, and less costly than IV fluids. It is more costly than many other oral fluids.

Which specific findings indicate severe dehydration in a child with acute diarrhea? Select all that apply. 1 Lethargy 2 Sunken eyes 3 Loss of skin turgor 4 Bradycardia 5 Dry mucous membranes

1,2,3,5 Lethargy and rapid, thready pulse indicate that the degree of dehydration is severe. These findings are not present when the degree of dehydration is moderate or mild. Sunken eyes, loss of skin turgor, and dry buccal mucous membranes can also be seen in both severe and moderate degrees of dehydration. Bradycardia is not indicative of severe dehydration.

Which terms describe the functions of the gastrointestinal tract? Select all that apply. 1 Secretory 2 Endocrine 3 Absorption 4 Circulatory 5 Immunologic

1,2,3,5 The various functions of the gastrointestinal tract include secretory, endocrine, absorption, and immunologic. The cardiac system has circulatory function.

Which are causes of acute diarrhea? Select all that apply. 1 Laxative use 2 Antibiotic therapy 3 Malabsorption syndromes 4 Upper respiratory infections 5 Inflammatory bowel disease

1,2,4 Causes of acute diarrhea include laxative use, antibiotic therapy, and upper respiratory infections. Malabsorption syndromes and inflammatory bowel disease are causes of chronic diarrhea

Which are secretions used in chemical digestion? Select all that apply. 1 Lipase 2 Insulin 3 Chyme 4 Mucous 5 Enzymes 6 Hydrochloric acid

1,2,4,5,6 Secretions used in chemical digestion include lipase, insulin, mucous, enzymes, and hydrochloric acid. Chyme is the result of chemical digestion. It is the partially digested food and water secretions that are delivered to the small intestines.

Which conditions can cause chronic diarrhea? Select all that apply. 1 HIV/AIDS 2 Celiac disease 3 Antibiotic therapy 4 Increased iron intake 5 Malabsorption causes

1,2,5 Causes of chronic diarrhea include HIV/AIDS, celiac disease, and malabsorption problems. Antibiotic therapy is considered an acute cause of diarrhea. Increased use of iron causes constipation, not diarrhea.

Which are common causes of functional constipation among school-age children? Select all that apply. 1 Stresses 2 Hypothyroidism 3 Environmental changes 4 Change in toileting pattern

1,3,4 Common causes of functional constipation among school-age children include stress, environmental changes, and change in toileting pattern. Hypothyroidism is an organic cause of constipation. Increased activity associated with sporting activities would promote normal stooling.

Which factors predispose a child to diarrhea? Select all that apply. 1 Poor sanitation 2 Sex of the child 3 Age of the child 4 Lack of clean water 5 Nutritional deficiency

1,3,4,5 Factors that predispose a child to diarrhea include poor sanitation, age of the child, lack of clean water, and nutritional deficiency. The sex of a child does not predispose the child to diarrhea.

When reviewing the endocrine causes of chronic diarrhea, the nursing instructor includes which medical problems? Select all that apply. 1 Hyperthyroidism 2 Hypothyroidism 3 Addison disease 4 Hirschsprung disease 5 Congenital adrenal hyperplasia

1,3,5 Endocrine causes of chronic diarrhea include hyperthyroidism, Addison disease, and congenital adrenal hyperplasia. Hypothyroidism tends to cause constipation rather than diarrhea. Hirschprung disease is a gastrointestinal motility disorder rather than an endocrine disorder.

Which symptoms are most associated with Crohn disease? Select all that apply. 1 Skip lesions 2 Telescoping bowel 3 Red, currant jelly-like stool 4 Inflammation involves any part of the GI tract 5 Inflammation is limited to the colon and rectum

1,4 Symptoms most associated with Crohn disease include skip lesions involving any part of the GI tract from mouth to anus. Ulcerative colitis is limited to the colon and rectum. A telescoping bowel with red, currant jelly-like stool is intussusception.

A nursing student receives report that a child has the diagnosis of failure to thrive. The nurse explains what failure to thrive means. Which statements are included in this explanation? Select all that apply. 1 Deceleration from growth patterns 2 The inability to maintain body functions conducive to life 3 A psychological condition where the patient has no desire to live 4 A condition that is sometimes accompanied by developmental delays 5 Consistently remaining below the fifth percentile for height and weight on standard growth charts

1,4,5 Failure to thrive is a deceleration from growth patterns or consistently remaining below the fifth percentile for height and weight on standard growth charts. It is sometimes accompanied by developmental delays. Failure to thrive does not mean the patient does not have the ability or desire to live.

Which is most associated with a child with a fecal impaction? 1 Dysphagia 2 Encopresis 3 Hematemesis 4 Failure to thrive

2 Encopresis is overflow of incontinent stool causing soiling. It is often caused by fecal retention or impaction. Dysphagia is difficulty swallowing and hematemesis is vomiting bright red blood. Failure to thrive is a deceleration from growth patterns or consistently remaining below the fifth percentile for height and weight on standard growth charts. It is sometimes accompanied by developmental delays.

Which are malabsorptive causes of chronic diarrhea? Select all that apply. 1 Crohn disease 2 Celiac disease 3 Ulcerative colitis 4 Lactose intolerance 5 Short-bowel syndrome

2,,4,5 Malabsorptive causes of chronic diarrhea include celiac disease, lactose intolerance, and short-bowel syndrome. Ulcerative colitis and Crohn disease are inflammatory bowel diseases.

Which conditions are associated with acute, severe pain? Select all that apply. 1 Pica 2 Appendicitis 3 Intussusception 4 Hirschsprung disease 5 Hypertrophic pyloric stenosis

2,3 Appendicitis and intussusception has acute, severe pain. Pica is an eating disorder characterized by the compulsive and excessive ingestion of both food and nonfood substances for at least 1 month. Hirschsprung disease is a mechanical obstruction of part of the intestine. Its symptoms include failure to pass stool, vomiting, and abdominal distention but not acute, severe pain. Hypertrophic pyloric stenosis has no evidence of pain except chronic hunger.

Which findings are most associated with ulcerative colitis? Select all that apply. 1 Skip lesions 2 Bloody diarrhea 3 Abdominal pain 4 Often associated with Helicobacter pylori 5 Palpable olive-shaped mass in the epigastrium just to the right of the umbilicus

2,3 Findings most associated with ulcerative colitis include bloody diarrhea and abdominal pain. Skip lesions are most associated with Crohn disease. An olive-shaped mass in the epigastrium just to the right of the umbilicus is most associated with pyloric stenosis. Peptic ulcer disease is often associated with Helicobacter pylori.

Which statements are true about intussusception? Select all that apply. 1 More common in females than males 2 Passage of red, currant jelly-like stools 3 Associated with sudden acute abdominal pain 4 The cause of intussusception is usually inflammation 5 Olive-shaped mass in the epigastrium just right of the umbilicus

2,3 Intussusception is associated with passage of red, currant jelly-like stools and sudden acute abdominal pain. It is more common in males than females and generally the cause is unknown (not inflammation). An olive-shaped mass in the epigastrium just right of the umbilicus is a finding associated with hypertrophic pyloric stenosis.

A young child is experiencing chronic constipation. Which interventions does the nurse recommend to promote regular bowel elimination? Select all that apply. 1 Decrease activity 2 Use of polyethylene glycol 3 Establish bathroom use routine 4 Increase dietary fiber and fluids 5 Increase iron and calcium supplements 6 Give child a bathroom time limit of 2 to 3 minutes

2,3,4 Interventions the nurse should recommend to promote regular bowel elimination include use of polyethylene glycol, establishment of bathroom use routines, and an increase of dietary fiber and fluids. Decreasing activity, increasing iron and calcium supplements, and rushing a child by only giving 2 to 3 minutes to completely evacuate the bowel promote constipation.

Which are the most common consequences of gastrointestinal disease in children? Select all that apply. 1 Obesity 2 Poor growth 3 Malnutrition 4 Malabsorption 5 Electrolyte disturbances

2,3,4,5 The most common consequences of gastrointestinal disease in children include poor growth, malnutrition, malabsorption, and electrolyte disturbances. Obesity is not associated with the consequences of gastrointestinal disease

The nursing instructor is teaching a group of student nurses about the similar and distinct features of the C urea breath test and the breath hydrogen test. Which statements of the student nurse indicates effective learning of the distinct features of the C urea breath test? Select all that apply. 1 "It is an invasive test." 2 "It uses labeled isotopes." 3 "It measures carbon dioxide." 4 "It detects the presence of bacteria." 5 "It is a gastrointestinal diagnostic procedure."

2,3,4,5 Unlike the breath hydrogen test, with the C urea breath test, breath is collected after ingesting isotopic urea with either carbon 13 or carbon 14. The test measures labeled carbon dioxide in expired air and detects the presence of Helicobacter pylori. H. pylori synthesize urease, the enzyme which hydrolyses urea to form ammonia and carbon dioxide. Both the C urea breath test and the breath hydrogen test are noninvasive tests. Both tests detect the presence of bacteria; however, the C urea breath test is specifically used to detect H. pylori and the breath hydrogen test is used to detect bacterial overgrowth and carbohydrate intolerance. Both tests are gastrointestinal diagnostic procedures.

Which clinical manifestations does the nurse observe in a child that confirms intussusception and to rule out hypertrophic pyloric stenosis? Select all that apply. 1 Vomiting 2 Acute abdominal pain 3 Currant jelly-like stools 4 Drawing the knees to the chest 5 Palpable olive-shaped tumor in the epigastrium 6 Palpable sausage-shaped mass in upper right quadrant

2,3,4,6 A child with intussusception has acute abdominal pain and passes currant jelly-like stools because venous engorgement causes leaking of blood and mucus into the intestinal lumen. The child draws the knees to the chest. A sausage-shaped mass is palpable in the upper right quadrant because in intussusception a proximal segment of the bowel telescopes into a more distal segment, pulling the mesentery with it. Compression of mesentery results in lymphatic and venous obstruction. Vomiting is seen both in intussusception and hypertrophic pyloric stenosis. In hypertrophic pyloric stenosis, an olive-shaped tumor is palpable in the epigastrium just to the right of the umbilicus because of the hypertrophied pylorus.

Which are causes of chronic diarrhea? Select all that apply. 1 Antibiotic therapy 2 Immunodeficiency 3 Malabsorption syndromes 4 Upper respiratory infections 5 Inflammatory bowel disease

2,3,5 Causes of chronic diarrhea include immunodeficiency, malabsorption syndromes, and inflammatory bowel disease. Antibiotic therapy and upper respiratory infections are acute causes of diarrhea.

Which statements about constipation are correct? Select all that apply. 1 Constipation can be a chronic disease process. 2 Constipation with fecal stooling is called encopresis. 3 Most children have no underlying cause identified for constipation. 4 Constipation is defined as an increased hardness of stool for at least 4 weeks. 5 Constipation is associated with drugs such as diuretics, antihistamines, and antieplileptics.

2,3,5 Statements that are correct related to constipation include: that constipation with fecal stooling is called encopresis and most children have no underlying cause identified for constipation. In addition, constipation is associated with drugs such as diuretics, antihistamines, and antieplileptics. It is not a chronic disease process and not defined as hardness of stool for 4 weeks, but for 2 weeks.

The nurse explains to the nursing student the various causes and conditions associated with acute diarrhea. Which topics are included in this discussion? Select all that apply. 1 Iron 2 Antibiotics 3 Immobility 4 Otitis media 5 Overfeeding

2,4,5 Causes and conditions associated with acute diarrhea include antibiotics, otitis media, and overfeeding. Iron and immobility contribute to constipation.

What are the similarities between ulcerative colitis and Crohn disease? Select all that apply. 1 Both disorders cause skip lesions. 2 Both are inflammatory bowel diseases. 3 Both disorders affect only colon and rectum. 4 Both are linked to variations in chromosome 6. 5 Both disorders involve Th17 cells in the disease process.

2,5 Ulcerative colitis and Crohn disease are two major forms of inflammatory bowel disease. They cause chronic intestinal inflammation. Both disorders involve Th17, a subset of T cells, in their inflammation process. Crohn disease causes skip lesions as the disease occurs in discontinuous fashion. This means there are areas of affected mucosa between areas of intact mucosa. Ulcerative colitis does not cause skip lesions, because the disease occurs in a continuous fashion. Whereas Crohn disease affects any part of the gastrointestinal tract from the mouth to the anus, ulcerative colitis affects only the colon and the rectum. Whereas Crohn disease is linked to variations in the NOD2 gene, ulcerative colitis is linked to variations in chromosome 6.

A nurse obtains an occult blood guaiac stool test. The solution is placed on the sample. Which color indicates the presence of blood in the stool? 1 Red 2 Blue 3 Black 4 Yellow

2. .A nurse obtains an occult blood guaiac stool test. The solution is placed on the sample. Which color indicates the presence of blood in the stool? 1 Red 2 Blue 3 Black 4 Yellow

A 10-year-old child brought to the emergency department is suspected of having appendicitis. Physical examination revealed tenderness at the McBurney point. The nurse asks the child to state the order in which the symptoms were experienced. Which order stated by the child suggests that the child has appendicitis? 1. Nausea 2. Periumbilical pain 3. Vomiting with fever 4. Right lower quadrant pain

2. Periumbilical pain 1. Nausea 4. Right lower quadrant pain 3. Vomiting with fever Classically, appendicitis involves a sequence of symptoms. The first symptom is periumbilical pain, then abdominal pain located around the umbilicus, followed by nausea. Pain shifts to the right lower quadrant as the inflammation progresses to involve the serosa of the appendix and the peritoneum of the abdominal wall. Finally it is followed by vomiting with fever. If the child's symptoms presented in that order, it suggests appendicitis. The McBurney point is the most common point of tenderness in a child with appendicitis. It is located two-thirds the distance along a line between the umbilicus and the anterosuperior iliac spine. The peak incidence of appendicitis is at 10 years of age

How soon in development are the esophagus and stomach considered identifiable? 1 At full term 2 Third trimester 3 4 weeks gestation 4 26 weeks gestation

3 Development of the esophagus and stomach are considered identifiable at 4 weeks gestation. At full term the mechanical functions of digestion are relatively immature but intact. At 26 weeks of gestation, uncoordinated contractions of the gastrointestinal (GI) tract occur, but emptying is slow. By the third trimester motility of the GI tract is improving.

Which drug therapy is the most effective for a 5-year-old child who has hepatitis B viral (HBV) infection? 1 Adefovir 2 Entecavir 3 Lamivudine 4 Pegylated interferon

3 In a 5-year-old child with HBV infection, treatment with lamivudine is most effective. It is used to treat HBV and is well tolerated with no significant side effects. Moreover, it is approved for children older than 3 years of age. Adefovir is also used to treat HBV but it should be used only in children older than 12 years of age. Entecavir is also used to treat HBV but it should be used in patients aged 16 years or older. Pegylated interferon is approved to treat hepatitis C viral infection in children 3 years of age or older.

Which stage of liver disease does the patient with chronic active hepatitis have if the pathology report of the patient shows fibrosis or scarring? 1 Stage 1 2 Stage 2 3 Stage 3 4 Stage 4

3 In chronic active hepatitis cases, liver function does not return completely. The liver disease progression can be characterized pathologically by four stages. Stage 3 is characterized by fibrosis or scarring. Stage 1 is characterized by mononuclear inflammatory cells surrounding small bile ducts. Stage 2 is characterized by proliferation of small bile ductules and, finally, stage 4 is characterized by liver cirrhosis.

Which nursing action is important in the care of a patient with cirrhosis after a liver biopsy? 1 Placing the patient in a prone position 2 Palpating for an olive-shaped mass 3 Monitoring hemoglobin and hematocrit 4 Assessing for red currant jelly-like stools

3 Monitoring hemoglobin and hematocrit is important after a liver biopsy, because the most common complication is internal bleeding. Placing the patient in the prone position is not appropriate, because it doesn't promote breathing. Right-side positioning is best. Pyloric stenosis is associated with an olive-shaped mass. Palpating for an olive-shaped mass would not be an expected nursing action. Red currant jelly-like stools are associated with intussusception, not cirrhosis or an expected complication of a liver biopsy.

The nurse is attending to an infant with esophageal atresia and a tracheoesophageal fistula. The infant is choking, regurgitating, and has frothy saliva and abundant mucus. Which intervention does the nurse choose to facilitate drainage of secretions into the stomach? 1 Monitoring airway patency 2 Administering oxygen as needed 3 Placing the infant in a supine position 4 Suctioning mouth and nose as necessary

3 The infant is placed in a supine position, because it facilitates drainage of secretions into the stomach and prevents aspiration. Airway patency is monitored to detect signs of airway occlusion. Oxygen is administered to prevent hypoxia. The mouth and nose are suctioned to relieve and prevent airway obstruction.

What is the similarity between an umbilical hernia and an inguinal hernia? 1 Both frequently become strangulated. 2 Both protrude through the abdominal wall. 3 Both are more prominent when an infant is crying. 4 Both cause incarceration often in infants less than 12 months of age.

3 Umbilical hernia and inguinal hernia are more prominent when an infant is crying, because crying causes strain on the protrusions. Strangulation of the hernias are rare. Inguinal hernia protrudes through the inguinal canal. However, umbilical hernia protrudes through the abdominal wall. Inguinal hernia often causes incarceration in infants less than 12 months of age; umbilical hernia rarely causes incarceration.

Which drug may be prescribed for a critically ill infant in an intensive care unit and is a histamine receptor antagonist that suppresses gastric acid production? 1 Bismuth 2 Sucralfate 3 Cimetidine 4 Lansoprazole

3 Cimetidine is the histamine receptor antagonist that suppresses gastric acid production. Histamine-receptor antagonists are given to critically ill infants to prevent stress ulcers and these drugs have fewer side effects. Bismuth and sucralfate are mucosal protective agents that form a barrier over ulcerated mucosa and protect against acid and pepsin. Lansoprazole is a proton pump inhibitor that inhibits the hydrogen ion pump in the parietal cells and blocks the production of acid.

What does the nurse teach a parent about careful food preparation to prevent food poisoning? Select all that apply. 1 "Do not freeze the ground meat." 2 "Always thaw food on the counter." 3 "Cook meat until the pink color disappears." 4 "Wash hands and utensils with hot, soapy water." 5 "Cook the meat to an internal temperature of 71°C."

3,4,5 Food poisoning occurs when there is overgrowth of harmful bacteria in food. The meat should always be cooked until gray inside. Presence of pink indicates that the meat is undercooked. Hands and utensils must be washed with hot, soapy water to prevent the spread of bacteria. Meat must be cooked to an internal temperature of 71°C. Ground meat should be quickly frozen to prevent spoilage and bacterial growth. Food should never be thawed on the counter because this encourages microbial growth.

Which are the most important basic assessments a nurse needs to perform for a child with gastrointestinal disease? Select all that apply. 1 Urease test 2 Romberg test 3 Intake and output 4 Height and weight 5 Abdominal examination

3,4,5 The most important basic assessments a nurse needs to perform for a child with gastrointestinal disease include intake and output, height and weight, and abdominal examination. The urease test is not a basic assessment. It involves a biopsy of the stomach. The Romberg test evaluates for neurologic function.

The child with severe diarrhea presents to the clinic for evaluation. The nurse assesses the patient for which complications of severe diarrhea? Select all that apply. 1 Fever 2 Encopresis 3 Dehydration 4 Metabolic acidosis 5 Metabolic alkalosis 6 Electrolyte imbalance

3,4,6 Major effects of fluid and electrolyte loss are dehydration, metabolic acidosis, and electrolyte imbalance. Fever may be a cause of fluid and electrolyte loss but is not caused by it. Encopresis is most associated with constipation, not with diarrhea. Metabolic alkalosis occurs with loss of acid and not specifically with the effects of fluid and electrolyte loss.

Which symptoms support the diagnosis of Crohn disease and ruling out of ulcerative colitis, based on the clinical manifestations in a child with inflammatory bowel disease? Select all that apply. 1 Diarrhea 2 Joint pain 3 Perianal lesions 4 Fever and weight loss 5 Fistulas and strictures 6 Extraintestinal manifestations

3,5,6 Perianal lesions, fistulas, and strictures are the features of Crohn disease and are rare in ulcerative colitis. Extraintestinal manifestations such as pyoderma gangrenosum, uveitis, and episcleritis are more common in Crohn disease than in ulcerative colitis. Diarrhea and joint pain are seen in both Crohn disease and ulcerative colitis. Fever and weight loss are usually seen in Crohn disease, but even some cases of ulcerative colitis may have fever and weight loss. Therefore, ulcerative colitis cannot be ruled out based on fever and weight loss.

Which agent is associated with alteration of normal intestinal flora by antibiotics? 1 Rotavirus 2 Salmonella 3 Escherichia coli 4 Clostridium difficile

4 Clostridium difficile is associated with alteration of normal intestinal flora by antibiotics. The most common causes of diarrhea in children are Salmonella and Escherichia coli; they are often foodborne.

A teen has a sigmoid colon bleed. The teen describes the stool as bright red. The nurse uses which term to document this report? 1 Melena 2 Meconium 3 Hematemesis 4 Hematochezia

4 Hematochezia is passage of bright red blood per rectum, usually indicating lower gastrointestinal (GI) tract bleeding. Melena is dark-colored, tarry stool that suggests upper GI bleeding such as from the stomach. Meconium is the first stool of a newborn. Hematemesis is vomiting bright red blood.

A child has constipation, abdominal distension, and ribbon-like stools. What does the nurse suspect? 1 Peptic ulcer 2 Appendicitis 3 Pyloric stenosis 4 Hirschsprung disease

4 Hirschsprung disease is associated with constipation, abdominal distension, and ribbon-like stools. Fever, rigid abdomen, and pain in the right lower abdomen are symptoms of appendicitis. Peptic ulcer is associated with epigastric pain and generalized abdominal pain and does not have ribbon-like stool. Pyloric stenosis is usually associated with projectile vomiting and an olive-shaped mass in the right epigastrium.

Which symptom does the nurse identify as the most common clinical manifestation of gastroesophageal reflux (GER) in an infant? 1 Gagging 2 Coughing 3 Excessive crying 4 Passive regurgitation

4 Passive regurgitation is the most common clinical manifestation of GER in an infant. Gagging, coughing, and excessive crying are some other clinical manifestations of GER in an infant; however, passive regurgitation is the most common one.

Parents reported to the nurse that their child is passing less than three hard stools per week for the past month. After performing oral clean out for 3 days, the child has been put on maintenance therapy. Which oral laxative is the best treatment choice for maintenance therapy? 1 Lactulose 2 Mineral oil 3 Milk and molasses 4 Polyethylene glycol

4 Polyethylene glycol is the best treatment choice for maintenance therapy due to the minimal side effects and taste. Moreover, it can be mixed with any drink, which makes it easier to administer to children. It also increases fluid in the colon and the additional volume of fluid stimulates the urge to defecate. Lactulose is also an oral laxative; however, it is less effective than polyethylene glycol. Mineral oil is also an oral laxative; however, it should be given carefully to avoid the risk of aspiration. The combination of milk and molasses is not an oral laxative; it is used for enema clean out.

After digestion is complete, which are the simplified nutrient end products? Select all that apply. 1 Bile 2 Lipase 3 Chyme 4 Fatty acids 5 Amino acids

4,5 After digestion is complete the simplified nutrient end products include fatty acids and amino acids. Bile is an emulsifying agent for fats that facilitates the digestion of fats by lipase and is necessary for absorption of the fat-soluable vitamins A, D, E, and K. Chyme is the partially digested food and water secretions that are delivered to the small intestines.